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may result in forfeiture of contractual payments. <br />I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid <br />for public works are true and correct. <br />Dated this aJ, J day of&-, v _, 20 ai <br />Contracto��er � it <br />Signature of Contractor/Bid r or Its Agent <br />Printed Name and Title <br />Subscribed and sworn to before me this � day of V —12011 <br />My Commission Expires 11011dn- �o�" <br />Notary Public <br />County of Residence <br />a v_hwk, <br />=HeavenEdwardsdwardsState of Indianaountyber NP0725779pires 0311112028 <br />Version 09/29/2021 Contractor's Bid for Public Works - 6 <br />